Tackling social taboos to end TB

Addressing social stigma is pivotal to eliminating TB. The ‘TB Free India Summit’ was one such initiative organized by the International Union Against TB and Lung Diseases (the Union), USAID and Challenge TB to promote zero stigma and zero discrimination towards TB patients. A key highlight of the meet was a cricket match between celebrities and parliamentarians at Dharamsala, India on April 7-8, 2017.
The event brought in its fold key decision makers such as state
governments, health experts, TB survivors, private players, media and
film celebrities to help raise the visibility of TB. In doing so, the
summit helped galvanize support and commitment from all the
participants. While such events are critical to help raise the profile
of TB to a larger audience, it is equally vital to make a concerted
effort to raise awareness among patients, their families and the
community.

I spoke with Buluma Saikia, General Secretary of the Auxiliary Nurse midwife (ANM) Association and Dr. Raman Gupta, a private practitioner, to gain an understanding of the different platforms and strategies adopted by them to dispel myths and misconceptions about the disease.

Auxiliary Nurse midwifes (ANMs) and Accredited Social Health Activists (ASHAs) are village-level female health workers are known as the first contact persons between the community and the health services. They are regarded as the grass-roots workers in the health organisation pyramid and form the backbone of the public health system in India. Members are usually from the community and form a vital link between the patient and his/her family and the primary health centre at village level.

When asked about awareness building in the community, Ms. Saikia remarked, “The attitude of patients, families and communities has changed considerably due to our efforts. Besides helping in early TB case detection and DOTS, we take the opportunity of the monthly meetings called the Mahila Arogya Samiti and the Village Health and Nutrition Days to raise awareness about TB and assure the community members that TB is curable." However, she added that counselling could be improved and DOT providers should also collaborate in these efforts.

In another part of the country, Dr. Raman Gupta, a private practitioner proudly informed that he has a picture of the film star Amitabh Bachchan in his clinic with the slogan ‘TB Harega, Desh Jeetega’ (The country will win and TB will be defeated). Dr Gupta counsels people when they are diagnosed with TB.

"When people are petrified on being diagnosed with TB, I assure them that they will become well again, just like their favourite star Amitabh Bachchan who also had TB but was cured and is still fit enough to work at the age of 75. If you take your medication timely and take care of your nutritional needs you will be fine," he tells his patients.

Even though he is a private practitioner he informs his patients that TB treatment is freely available at the government health centres. He however highlighted the need to engage with and build awareness amongst other private providers as an estimated 60% of the TB patients are treated in the private sector in India. Rightly so, the Indian government’s "National Strategic Plan to Eliminate TB by 2025" clearly recommends increased engagement with the private sector.

On being asked what would be the best approach to bring about this change, Dr. Gupta quipped, "Bebinca approach- a strategy that will build awareness from both top down to bottom up - similar to the manner in which the Goan dessert “Bebinca” is prepared; by applying heat from the top and the bottom."

India has the highest TB burden globally accounting for nearly one fourth of the global incidence - an estimated 2.2 million cases against global incidence of 9.6 million annually. Tackling social taboo at all levels with the engagement of all stakeholders is critical to stem the tide of TB in India and elsewhere. Indeed TB Harega, Desh Jeetega!Dr Abha Jaiswal, CNS Correspondent, India August 9, 2017